Elevated serum uric acid (SUA) has been associated with vascular cognitive impairment (CI) in the elderly. However, its relationship with cognitive function in the elderly patients receiving maintenance hemodialysis (MHD) has not yet been elucidated.The cognitive impairment is prevalent in MHD patients. Various insults may contribute to cognitive impairment in patients with MHD. The aim of this study was to investigate the relationship between SUA and CI in the elderly patients receiving MHD.A total of 180 elderly MHD subjects from two hospitals were enrolled in our study. Cognitive function domains were evaluated by MMSE at the beginning of the trial. Demographic and clinical characteristics were collected and recorded.The subjects were stratified into quartiles according to SUA level. Demographic and clinical characteristics such as age, gender, smoking habit, education year, blood pressure (BP), hemoglobin, albumin, blood glucose (BG), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), blood urea nitrogen (BUN), and serum creatinine (Scr) did not differ dramatically among groups (p > .05). The Q1 group showed the highest MMSE scores, and the Q4 group showed the lowest MMSE sores (p < .05). There was a negative correlation between SUA and MMSE scores (r = -.307, p = .014), and this correlation was independent of demographic and clinical characteristics.Elevated SUA maybe contributes to CI in the elderly MHD patients. SUA level is independent risk for the CI in the elderly MHD patients.